A case of onycholysis

Case scenario

A 39-year-old woman presented with an eight-month history of ‘lifting fingernails’. The left thumbnail was the first affected, and gradually more nails had become involved. The distal part of the affected nail plates had a yellow discolouration and these nails were not attached to the distal nail bed (Figures 1a and b). The nail plates were of normal thickness and did not appear to be brittle. Apart from the annoyance of the nails being more easily caught on things, they were asymptomatic. She was scared to cut the affected nails so left them longer. Her toenails were normal.

There was no history suggesting inflammation of the distal fingers and she was otherwise well, with no past history of other skin diseases. She had otherwise normal skin. Her father had moderately active psoriasis not affecting his nails or joints. She denied manicuring her nails and she did not often have her hands in water. Her GP ordered two sets of nail clippings for fungal culture; there was no growth on the first occasion and a light growth of Candida albicans on the second set of clippings. She had been taking no medications.